Provider Demographics
NPI:1285735407
Name:LABORATORIO CARDIOVASCULAR DEL NORTE INC
Entity type:Organization
Organization Name:LABORATORIO CARDIOVASCULAR DEL NORTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-854-3826
Mailing Address - Street 1:PO BOX 12003
Mailing Address - Street 2:CAPARRA HEIGHTS STA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-2003
Mailing Address - Country:US
Mailing Address - Phone:787-854-3826
Mailing Address - Fax:787-884-5334
Practice Address - Street 1:LAB. CARDIOVASCULAR DEL NORTE-HOSPITAL DOCTORS CENTER
Practice Address - Street 2:SUITE 301, THIRD FLOOR, #2 STREET
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0000
Practice Address - Country:US
Practice Address - Phone:787-854-3826
Practice Address - Fax:787-884-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4954246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028373Medicare PIN